To the Editor.
—We read with interest the article by Drs Adler and Ropper regarding pulsatile tinnitus and abnormalities of the jugular bulb.1 We have had an interest in pulsatile tinnitus, and, over the last seven years, have seen 25 patients with this unusual complaint (Table).2 In our experience, patients with objective pulsatile tinnitus (heard by the patient and examiner alike) are likely to have angiographic evidence of an arterial abnormality, such as a dural arteriovenous malformation, affecting the transverse venous sinus or significant intra- or extracranial arterial occlusive disease. In comparison, subjective pulsatile tinnitus (heard only by the patient) may fluctuate with maneuvers, such as head turning or lightResults of Evaluation in 25 Patients With Pulsatile Tinnitus Objective pulsatile tinnitus Normal 2 Arteriovenous malformation Dural (transverse sinus) 5 Pial (parietal cortex) 1 Total 6 Occlusive arterial disease Ipsilateral siphon stenosis 3 Ipsilateral carotid stenosis 2 Contralateral carotid occlusion 2
Sila CA, Furlan AJ. Venous Bruit, Jugular Bulb, and Increased Intracranial Pressure. Arch Neurol. 1986;43(9):868. doi:10.1001/archneur.1986.00520090008006